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AlcoholEdu for High School

AlcoholEdu for High School is an online, interactive, alcohol education and prevention course designed to increase alcohol-related knowledge, discourage acceptance of underage drinking, and prevent or decrease alcohol use and its related negative consequences. Although high schools typically administer the course to their entire freshman class each year, the course can be used with other high school populations as well. By implementing the program at the population level, schools expose students to a consistent message, ultimately creating a common body of knowledge and a shared experience that helps establish a social safety net among students. The program includes a precourse assessment measuring knowledge, attitudes, and behaviors, followed by three 30-minute lessons, a postcourse assessment, and a 30-day (or more) follow-up review of key course concepts and follow-up assessment. The three lessons address alcohol's effects on the body and impairments produced at various blood alcohol concentrations; alcohol's effects on the mind, including brain development, blackouts, hangovers, and risk taking; and factors that influence decisions about drinking and strategies for making healthy choices. Brief lecture formats present current research, and interactive exercises personalize and reinforce the information. The course, which requires minimal teacher involvement, may be assigned as an outside project or completed in a school's computer lab.

Students can progress through the program at their own pace. Although students have unlimited access to the course materials throughout the academic year, schools are encouraged to tie the course to something that is meaningful to the students, such as a test or project grade, access to a school event, or participation in extracurricular activities. The three lessons are typically completed within 1 to 3 weeks. Students may use their accounts throughout the academic year to access alcohol-related Web links or revisit any of the different interactive exercises.

Descriptive Information

Areas of Interest	Substance abuse prevention
Outcomes	Review Date: May 2008 1: Current alcohol use and intention to change drinking status 2: Acceptance of underage drinking/drunkenness 3: Knowledge about alcohol 4: Riding in a car with a driver who has been drinking 5: Perceived ability to limit drinking
Outcome Categories	Alcohol
Ages	13-17 (Adolescent)
Genders	Male Female
Races/Ethnicities	American Indian or Alaska Native Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	School
Geographic Locations	Urban Suburban Rural and/or frontier
Implementation History	Since first being implemented in 2004, AlcoholEdu for High School has been used in 185 public and private high schools across the United States in geographically, economically, and demographically diverse districts and has reached nearly 35,000 students. Student outcomes have been measured in more than 85% of these high schools. The course is also being implemented in an American high school in the European Union.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: No Evaluated in comparative effectiveness research studies: No
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Universal

Quality of Research

Review Date: May 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Outside The Classroom, Inc. (2008). Analyses and results for 2006-2007 institutional cycle design (study 1) and supplemented analyses and results for 2005-2006 matched-participant analysis (study 2). Needham, MA: Author.

Outside The Classroom, Inc. (2008). Follow-up responses to reviewer questions regarding participation rates, analysis plan, and outcome measures. Needham, MA: Author.

Study 2

Outside The Classroom, Inc. (2006). NREPP application summary for AlcoholEdu for High School. Needham, MA: Author.

Outside The Classroom, Inc. (2008). Follow-up responses to reviewer questions regarding participation rates, analysis plan, and outcome measures. Needham, MA: Author.

Supplementary Materials

Outside The Classroom, Inc. (2006). AlcoholEdu for High School evaluative report: North Dakota--aggregate. Needham, MA: Author.

Outside The Classroom, Inc. (2006). AlcoholEdu for High School executive summary: North Dakota public high schools. Needham, MA: Author.

Mothers Against Drunk Driving. (2007). Final Report to the Office of Justice Programs, Office of Juvenile Justice and Delinquency Programs, State of New Mexico, Children, Youth, and Families Department.

Outcomes

Outcome 1: Current alcohol use and intention to change drinking status
Description of Measures	Current alcohol use and intention to change drinking status were measured using an item that read, "Please mark which of the following best matches your situation." Response options included 1 (I don't drink); 2 (I drink, and I see no need to change the way I use alcohol); 3 (I drink, and I am currently thinking about reducing how much I drink or stopping drinking entirely); 4 (I drink, and I am ready to try reducing how much I drink or stopping drinking entirely); and 5 (I drink, and in the past month, I have reduced how much I drink or stopped drinking entirely).
Key Findings	The percentage of students who reported not drinking was significantly higher among students completing the course than among the control group (76.7% vs. 73.9%, p < .001). In addition, the percentage of students who reported that they drink and see no need to change their alcohol use was significantly lower among students completing the course than among the control group (13.1% vs. 14.7%, p < .001). Among students who were drinkers--those who responded "yes" to "Have you ever had a drink of alcohol (other than a few sips)?"--treatment group participants had less approving attitudes toward drinking than control group participants (p < .001).
Studies Measuring Outcome	Study 1
Study Designs	Quasi-experimental
Quality of Research Rating	2.0 (0.0-4.0 scale)

Outcome 2: Acceptance of underage drinking/drunkenness
Description of Measures	Acceptance of underage drinking/drunkenness was measured using an item that read, "Which of the following best represents your own attitude about alcohol for people under the age of 21?" Response options included 1 (Drinking is never okay); 2 (Drinking is okay, but a person should never get drunk); 3 (Occasionally getting drunk is okay as long as it doesn't interfere with school or other responsibilities); 4 (Occasionally getting drunk is okay even if it does interfere with school or other responsibilities); and 5 (Frequently getting drunk is okay).
Key Findings	In one study, students who completed the course were significantly less accepting of underage drinking than control students, with mean scores of 1.89 and 2.16, respectively (p < .001). In a second study, the percentage of students reporting that drinking alcohol is never acceptable for people under the age of 21 increased significantly from 37.8% at baseline to 47.5% 1 month after completing the course (p < .001).
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Quasi-experimental, Preexperimental
Quality of Research Rating	1.9 (0.0-4.0 scale)

Outcome 3: Knowledge about alcohol
Description of Measures	Knowledge about alcohol was measured using a 10-question precourse test and 20-question postcourse test reflecting the content delivered in the course. For each student, the items were randomly selected from a bank of 45 knowledge questions. Students who correctly answered at least 70% of the questions passed the test.
Key Findings	The percentage of students passing the knowledge test increased by 32% from pretest to posttest (p < .01), with 93% of students passing the test after completing the course. The average score on the test increased from 66% to 84%.
Studies Measuring Outcome	Study 2
Study Designs	Preexperimental
Quality of Research Rating	2.0 (0.0-4.0 scale)

Outcome 4: Riding in a car with a driver who has been drinking
Description of Measures	Students were asked about the number of times in the past 30 days they had ridden in a vehicle driven by someone who had been drinking. Response options ranged from 1 (never) to 6 (every day).
Key Findings	The percentage of students reporting they had ridden with a driver who had been drinking decreased significantly from 27.1% at baseline to 23.5% 1 month after completing the course (p < .001).
Studies Measuring Outcome	Study 2
Study Designs	Preexperimental
Quality of Research Rating	2.1 (0.0-4.0 scale)

Outcome 5: Perceived ability to limit drinking
Description of Measures	Perceived ability to limit drinking was measured using an item that read, "If I were drinking, I would be able to limit my drinking when I needed to." Response options ranged from 1 (strongly agree) to 5 (strongly disagree).
Key Findings	The percentage of students reporting they could limit their drinking increased significantly from 44.9% at baseline to 55.1% 1 month after completing the course (p < .001).
Studies Measuring Outcome	Study 2
Study Designs	Preexperimental
Quality of Research Rating	1.8 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	13-17 (Adolescent)	53.1% Female 46.9% Male	81.6% White 6.7% Hispanic or Latino 4.5% Black or African American 4.2% Asian 2.1% Race/ethnicity unspecified 0.9% American Indian or Alaska Native
Study 2	13-17 (Adolescent)	50.8% Female 49.2% Male	84.7% White 4.4% Black or African American 4.2% Asian 2.9% Hispanic or Latino 2.8% Race/ethnicity unspecified 1% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

1. Reliability of measures	4. Missing data and attrition
2. Validity of measures	5. Potential confounding variables
3. Intervention fidelity	6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Current alcohol use and intention to change drinking status	1.0	2.0	2.3	2.3	2.0	2.3	2.0
2: Acceptance of underage drinking/drunkenness	1.0	2.0	2.3	2.0	2.0	2.3	1.9
3: Knowledge about alcohol	2.0	2.0	2.3	2.0	1.5	2.3	2.0
4: Riding in a car with a driver who has been drinking	2.3	2.3	2.3	2.3	1.3	2.3	2.1
5: Perceived ability to limit drinking	1.5	1.8	2.3	1.5	1.3	2.3	1.8

Study Strengths

The standardized online course facilitated the consistent delivery of program content. Participants were required to complete pre- and postcourse knowledge tests as a proximal measure of sufficient program exposure and assurance that students obtained a minimum standard of knowledge. The validity of the behavioral and attitudinal questions was strengthened by the online format of the assessments and assurances of anonymity. The sample sizes were very large.

Study Weaknesses

Key behavioral and attitudinal outcomes relied on single-item measures with no established reliability or validity metrics. The study designs and the potential selection biases introduced by the low participation rate among schools implementing the program limit the ability to attribute changes in behavior and attitudes to the intervention. Statistical analyses were adequate to test hypotheses but did not take school-level effects into account.

Readiness for Dissemination

Review Date: May 2008

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

AlcoholEdu for High School: Client Experience

AlcoholEdu for High School online course, http://highschool.alcoholedu.com

AlcoholEdu Hub (administrative site), http://www.alcoholedu.com/hub/login.aspx

Outside The Classroom, Inc. (2003). AlcoholEdu for High School course post-survey. Needham, MA: Author.

Outside The Classroom, Inc. (2003). AlcoholEdu for High School course pre-survey. Needham, MA: Author.

Outside The Classroom, Inc. (2003). AlcoholEdu for High School follow-up survey. Needham, MA: Author.

Outside The Classroom, Inc. (2007). 2007-2008 implementation map: AlcoholEdu for High School programs & services. Needham, MA: Author.

Outside The Classroom, Inc. (2007). AlcoholEdu for High School: Information technology reference guide 2007-2008. Needham, MA: Author.

Outside The Classroom, Inc. (2007). AlcoholEdu for High School: Learning about AlcoholEdu for High School 2007-2008. Needham, MA: Author.

Outside The Classroom, Inc. (2007). AlcoholEdu for High School: Preparing for your AlcoholEdu for High School 2007-2008. Needham, MA: Author.

Outside The Classroom, Inc. (2007). Preparing for your AlcoholEdu implementation: Your implementation worksheet. Needham, MA: Author.

Outside The Classroom, Inc. (2007). Your implementation checklist. Needham, MA: Author.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.0	3.4	2.5	3.0

Dissemination Strengths

This online intervention includes content for both students and parents along with supplementary materials to help organizations prepare for implementation. The information technology guide clearly outlines necessary computer system requirements. The online format of the course eliminates the need for facilitator training on intervention delivery. Technical assistance is available to support schools during implementation. Pre- and postcourse surveys are incorporated into the online delivery of the program as quality assurance tools.

Dissemination Weaknesses

Little guidance is provided on how to integrate this intervention into the regular school schedule. There is limited support for tailoring the program to address diverse cultural groups or varied literacy levels. Little information is provided to implementers on how data derived from quality assurance procedures should be used to improve program delivery.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Annual license	$995-$5,995 per site	Yes

Additional Information

The annual license includes unlimited access to the AlcoholEdu for High School and AlcoholEdu for Parents courses; the implementation guide and implementation worksheet; implementation support and consultation; access to an administrative Web site for tracking student progress and completion; and a comprehensive evaluation package. Multischool and multiyear discounts are available.

Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
John Boynton
(877) 338-5001 ext 133
john@everfi.com

To learn more about research, contact:
William DeJong, Ph.D.
(781) 726-6677 ext 127
bill@everfi.com

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):

http://www.outsidetheclassroom.com/solutions/high-school/alcoholedu-for-high-school.aspx